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. 2025 Aug 29:17:143566.
doi: 10.52965/001c.143566. eCollection 2025.

Preoperative strategies to prevent periprosthetic joint infection after knee replacement: evidence-based recommendations for multidisciplinary practice

Hassan Zmerly  1   2 , Ibrahim Akkawi  3 , Manuela Moscato  4 , Riccardo Galletti  5 , Valentina Di Gregori  6 , Francesco Pegreffi  7   8
Affiliations

Preoperative strategies to prevent periprosthetic joint infection after knee replacement: evidence-based recommendations for multidisciplinary practice

Hassan Zmerly et al. Orthop Rev (Pavia). .

Abstract

Periprosthetic joint infection (PJI) is a severe and challenging complication following joint replacement that significantly impacts patient outcomes and implant longevity. Various factors contribute to PJI onset, including patient-related comorbidities and surgical procedures. Preventive strategies are categorized into preoperative, perioperative, and postoperative measures. Preoperative risk factors can be classified as general or local. General ones include comorbidity management (metabolic disorder, rheumatic and inflammatory diseases), nutritional optimization, weight control, bacterial decolonization, and lifestyle modifications. Local factors involve avoiding intra-articular injections before surgery and assessing previous knee interventions, in addition to implementing preoperative physiotherapy and ensuring proper skin preparation. Preoperative patient optimization significantly improves outcomes following knee replacement by reducing PJI risk, as well as hospital stays and recovery times. Implementing standardized, evidence-based preoperative strategies can enhance surgical success and long-term implant survival. Multidisciplinary collaboration between surgeons, general practitioners, and healthcare providers is essential to minimize infection risks and improve patient outcomes following joint replacement. This paper focuses on preoperative optimization, highlighting evidence-based recommendations to minimize the risk of PJI in patients undergoing knee replacement.

Keywords: Periprosthetic joint infection; bacterial decolonization; joint replacement; knee replacement; prevention.

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